Cardiovascular Surgery Practice Remodel: Increasing Job Satisfaction and Reducing Turnover Rates of Advanced Practice Providers

Cardiovascular Surgery Practice Remodel: Increasing Job Satisfaction and Reducing Turnover Rates of Advanced Practice Providers Background: The CVS practice in a Midwestern state had a shift in morale and job satisfaction in their advanced practice providers (APPs). This shift lead to the high turnover rate of 35% in 2018. In an effort to bring a halt to the high turnover rate, and to continue the excellent patient care for which the hospital is known, hospital administration became involved and set up a committee to guide the development of a new CVS APP practice model. The goal was to develop a practice model that allowed the continuation of excellent patient care, with APP job satisfaction and role clarity, and lower the turnover in the department of CVS. Purpose: APP’s turnover rates are at a record high not only for the CVS department, but they are also high across the nation. The goal of this research study is to assess the job satisfaction and turnover rate of CVS APPs before and after the implementation of the new practice model. The goal of the new practice model would be improved job satisfaction and low to no turnover after its implementation. Methods: The APP job satisfaction and retention rates were compared before and after the implementation of the new practice model. All CVS APP staff members were included in the study by default as all staff members were sent the Sirota survey and all staff was included in the retention and turnover rates. Turnover rates and job satisfaction were analyzed using a paired sample comparison. Discussion: Suggestions would be to send more specific surveys to the APPs to determine more specifically if the satisfaction was due to the practice model change or the difference in year to year satisfaction. The data collection will continue every 3-6 months after this scholarly project completion to continue workflow adjustments as necessary. Limitations: The study and data collection are lacking as it was limited to only nine months after the implementation of the new practice model. The inpatient APPs also worked understaffed throughout the study and still had seven APP openings at the end of 2019. There were two unexpected interdepartmental transfers when new positions in the hospital opened that held special interest to some of the APP staff. The inpatient APPs did not have an opportunity within this study timeframe to work in fully staffed conditions and this may have contributed to APP burnout and frustration. Results: The turnover rates decreased from 35% to 8% in one year and the job satisfaction rates increased from 83% to 94% for the inpatient providers and from 83% to 100% for in outpatient providers. The work culture also increased for both groups with the inpatient providers work culture increasing from 68% to 84% and increasing in the outpatient providers from 50% to 89%. These increases are significant and demonstrate the positive impact of the practice remodel revision

Active Pharmaceutical Ingredients and Aquatic Organisms

The presence of active pharmaceuticals ingredients (APIs) in aquatic systems has led in recent years to a burgeoning literature examining environmental occurrence, fate, effects, risk assessment, and treatability of these compounds. The vast preponderance of studies aimed at identifying and quantifying contaminant residues in aquatic tissues have involved the conventional and legacy pollutants. Comparatively few studies have been targeted at APIs, primarily those that are lipophilic. Although APIs have received much attention as emerging contaminants of concern, it is important to recognize that traditional approaches to understand and predict exposure and effects of other environmental organic contaminant classes mayor may not be appropriate for APIs. For example, traditional approaches for understanding aquatic effects may not be as useful for some APIs (Brooks et al. 2003), but lessons learned from the study of compounds active at the hypothalamicpituitary- gonadal axis (endocrine disruptors/modulators) may reduce uncertainties associated with environmental assessments of other APIs (Ankley et al. 2007)

A new model defines the minimal set of polymorphism in HLA-DQ and -DR that determines susceptibility and resistance to autoimmune diabetes

Abstract Background The mechanism underlying autoimmune diabetes has been difficult to define. There is a strong genetic contribution and numerous studies associate the major histocompatibility complex, especially the class II region, with predisposition or resistance. However, how these molecules are implicated remains obscure. Presentation of the hypothesis We have supplemented structural analysis with computational biophysical and sequence analyses and propose an heuristic for distinguishing between human leukocyte antigen molecules that predispose to insulin dependent diabetes mellitus and those that are protective. Polar residues at both β37 and β9 suffice to distinguish accurately between class II alleles that predispose to type 1 diabetes and those that do not. The electrostatic potential within the peptide binding pocket exerts a strong influence on diabetogenic epitopes with basic residues. Diabetes susceptibility alleles are predicted to bind autoantigens strongly with tight affinity, prolonged association and altered cytokine expression profile. Protective alleles bind moderately, and neutral alleles poorly or not at all. Non-Asp β57 is a modifier that supplements disease risk but only in the presence of the polymorphic, polar pair at β9 and β37. The nature of β37 determines resistance on one hand, and susceptibility or dominant protection on the other. Conclusion The proposed ideas are illustrated with structural, functional and population studies from the literature. The hypothesis, in turn, rationalizes their results. A plausible mechanism of immune mediated diabetes based on binding affinity and peptide kinetics is discussed. The number of the polymorphic markers present correlates with onset of disease and severity. The molecular elucidation of disease susceptibility and resistance paves the way for risk prediction, treatment and prevention of disease based on analogue peptides. Reviewers This article was reviewed by Eugene V. Koonin, Michael Lenardo, Hossam Ashour, and Bhagirath Singh. For the full reviews, please go to the Reviewers' comments section.</p

Active Pharmaceutical Ingredients and Aquatic Organisms

The presence of active pharmaceuticals ingredients (APIs) in aquatic systems has led in recent years to a burgeoning literature examining environmental occurrence, fate, effects, risk assessment, and treatability of these compounds. The vast preponderance of studies aimed at identifying and quantifying contaminant residues in aquatic tissues have involved the conventional and legacy pollutants. Comparatively few studies have been targeted at APIs, primarily those that are lipophilic. Although APIs have received much attention as emerging contaminants of concern, it is important to recognize that traditional approaches to understand and predict exposure and effects of other environmental organic contaminant classes mayor may not be appropriate for APIs. For example, traditional approaches for understanding aquatic effects may not be as useful for some APIs (Brooks et al. 2003), but lessons learned from the study of compounds active at the hypothalamicpituitary- gonadal axis (endocrine disruptors/modulators) may reduce uncertainties associated with environmental assessments of other APIs (Ankley et al. 2007)

Modeling the public health impact of malaria vaccines for developers and policymakers

Efforts to develop malaria vaccines show promise. Mathematical model-based estimates of the potential demand, public health impact, and cost and financing requirements can be used to inform investment and adoption decisions by vaccine developers and policymakers on the use of malaria vaccines as complements to existing interventions. However, the complexity of such models may make their outputs inaccessible to non-modeling specialists. This paper describes a Malaria Vaccine Model (MVM) developed to address the specific needs of developers and policymakers, who need to access sophisticated modeling results and to test various scenarios in a user-friendly interface. The model's functionality is demonstrated through a hypothetical vaccine.; The MVM has three modules: supply and demand forecast; public health impact; and implementation cost and financing requirements. These modules include pre-entered reference data and also allow for user-defined inputs. The model includes an integrated sensitivity analysis function. Model functionality was demonstrated by estimating the public health impact of a hypothetical pre-erythrocytic malaria vaccine with 85% efficacy against uncomplicated disease and a vaccine efficacy decay rate of four years, based on internationally-established targets. Demand for this hypothetical vaccine was estimated based on historical vaccine implementation rates for routine infant immunization in 40 African countries over a 10-year period. Assumed purchase price was $5 per dose and injection equipment and delivery costs were$0.40 per dose.; The model projects the number of doses needed, uncomplicated and severe cases averted, deaths and disability-adjusted life years (DALYs) averted, and cost to avert each. In the demonstration scenario, based on a projected demand of 532 million doses, the MVM estimated that 150 million uncomplicated cases of malaria and 1.1 million deaths would be averted over 10 years. This is equivalent to 943 uncomplicate cases and 7 deaths averted per 1,000 vaccinees. In discounted 2011 US dollars, this represents $11 per uncomplicated case averted and$1,482 per death averted. If vaccine efficacy were reduced to 75%, the estimated uncomplicated cases and deaths averted over 10 years would decrease by 14% and 19%, respectively.; The MVM can provide valuable information to assist decision-making by vaccine developers and policymakers, information which will be refined and strengthened as field studies progress allowing further validation of modeling assumptions

A New Formulation for the Removal and Remediation of Polychlorinated Biphenyls in Painted Structures

This new technology report will describe the laboratory development of a new and innovative solution for the removal and destruction of PCBs found in painted structures or within the binding or caulking material on structures. The technology incorporates a Bimetallic Treatment System (BTS) that extracts and degrades only the PCBs found on the facilities, leaving in most cases the structure virtually unaltered